1699734509 NPI number — UNITED MEDICAL INCORPORATED

Table of content: (NPI 1699734509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699734509 NPI number — UNITED MEDICAL INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED MEDICAL INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699734509
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4654 HAYGOOD RD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23455-5448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-363-7746
Provider Business Mailing Address Fax Number:
757-363-8225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4654 HAYGOOD RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23455-5448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-363-7746
Provider Business Practice Location Address Fax Number:
757-363-8225
Provider Enumeration Date:
03/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NORMAN
Authorized Official First Name:
LISA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
757-363-7746

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7703088 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1057007 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 260745 . This is a "BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 009111719 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017100000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1161 . This is a "GENTIVA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1018888 . This is a "ACM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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